Birth trauma is a cumulative concept that combines possible damage to the organs of the mother and child, the integrity of their tissues during childbirth. Specialists refer to birth injuries as hematomas, ruptures of the internal genitalia of a woman, fistulas formed, as well as changes in the pelvic bones. Some injuries received during childbirth can lead to serious consequences, and in some cases even to death.
The content of the article:
Birth injuries of the vulva and vagina
Birth injuries of the perineum
Birth injuries of the uterus
Other birth injuries
Common causes of birth injuries of the mother
Prevention of birth injuries
Birth trauma
It is possible to diagnose birth injuries during an external gynecological examination and with further laboratory examination of the seized material. When a woman in labor receives injuries of generic origin, urgent intervention of professionals of a narrow profile is necessary: specialists in the field of urology, proctology, traumatology and surgery.
Childbirth is a great stress for the mother and baby’s body, so in medicine it is customary to distinguish two types of birth injuries: children’s and maternal. In newborns, due to severe childbirth, there may be violations of the functionality of the nervous system, injury to body parts, bones, organs.
During the birth act, a woman has an expansion of the birth canal, which provokes a violation of their integrity. Birth injuries are:
superficial: scratches, abrasions that heal after some time without the intervention of specialists;
unrecognized: the resulting violation is asymptomatic.
Sometimes injuries received during childbirth cause disability and death of a woman, a newborn baby. The most common injuries sustained during childbirth are considered to be ruptures of the vulva, perineum and various hematomas.
The resulting birth injuries lead to serious complications in the functioning of the female body and contribute to the emergence of a large number of problems throughout life.
If you do not sew up the rupture of the cervix, then the next pregnancy of a woman may end in spontaneous termination of pregnancy. It is possible to avoid miscarriage only after suturing by qualified specialists.
The rupture of the perineum can lead to the omission of the female genitals. Some doctors decide not to sew up the tears, hoping that over time they will heal themselves. But this is far from the case — omission of the genitals requires a serious and long-term treatment process followed by surgical intervention.
Quite often, women after the birth of a child have a violation of blood supply and local necrosis. This phenomenon is provoked by a large fruit and the placement of its head in one position. If the head blocks the access of blood in places where the vagina and rectum, urethra and vagina come into contact, a fistula develops. This pathology negatively affects the functioning of the female body and is subject to surgical therapy.
Despite the success of suturing damaged tissues, the adverse effects of birth injuries cannot always be avoided, because a small scar remains in the places of suturing. It is with the scars that all the unpleasant sensations of a woman in the genital area and possible complications during the next birth are associated, since the seams can simply break.
Birth injuries of the vulva and vagina
Vulva tissues during childbirth are most often disturbed near the labia minora or clitoris. Violations manifest themselves in the form of cracks and tears. If the tear occurred in the clitoris area, severe bleeding is observed in women in labor, as blood vessels are damaged.
Treatment of the injured vulva consists in applying a special seam with a thin catgut. When sewing up the wounds that have arisen at the clitoris, a urine catheter must be inserted into the urethra. Stitches should be applied very carefully so as not to provoke severe bleeding.
Vaginal injuries are very common in combination with ruptures of the perineum, cervix. Vaginal lesions occur deep in the layers, but the mucous membrane itself is not disturbed. At the site of vascular damage, hematomas are formed that can reach enormous sizes. It is absolutely not difficult to diagnose a vaginal rupture, because during a gynecological examination, a hematoma cannot go unnoticed. If the hematoma is small, then after a while it can resolve itself, but a strong rupture of the walls must be sewn up with a continuous seam. Sometimes the bleeding is so severe that it becomes simply impossible to perform the operation. In order to stop the outpouring of blood, the hematoma is opened, emptied and stitched on the vessels, and if necessary, on the tissues. For the treatment of large hematomas, a drainage shaped like a rubber strip is sometimes used.
Birth injuries of the perineum
Vulva tissues during childbirth are most often disturbed near the labia minora or clitoris. Violations manifest themselves in the form of cracks and tears. If the tear occurred in the clitoris area, severe bleeding is observed in women in labor, as blood vessels are damaged.
Treatment of the injured vulva consists in applying a special seam with a thin catgut. When sewing up the wounds that have arisen at the clitoris, a urine catheter must be inserted into the urethra. Stitches should be applied very carefully so as not to provoke severe bleeding.
Vaginal injuries are very common in combination with ruptures of the perineum, cervix. Vaginal lesions occur deep in the layers, but the mucous membrane itself is not disturbed. At the site of vascular damage, hematomas are formed that can reach enormous sizes. It is absolutely not difficult to diagnose a vaginal rupture, because during a gynecological examination, a hematoma cannot go unnoticed. If the hematoma is small, then after a while it can resolve itself, but a strong rupture of the walls must be sewn up with a continuous seam. Sometimes the bleeding is so severe that it becomes simply impossible to perform the operation. In order to stop the outpouring of blood, the hematoma is opened, emptied and stitched on the vessels, and if necessary, on the tissues. For the treatment of large hematomas, a drainage shaped like a rubber strip is sometimes used.
Birth injuries of the uterus
Rupture of the uterus is a complex injury that can cause the death of the mother. Severe consequences are caused by blood loss, shock, so they always need emergency surgery. Fortunately, such damage is quite rare — up to 0.1% of the total number of births performed. The rehabilitation period takes a long time, as purulent complications can develop. When the uterus ruptures, the child has no chance of survival, so such an injury becomes the cause of fetal death.
Risk group for possible rupture of the uterus:
women with scars after a previous cesarean section, artificial abortion and uterine perforation;
pregnant women who have already given birth several times, had an abortion and suffered from complications after pregnancy and abortions;
women with a mismatch between the size of the fetus and the pelvis;
the presence of multiple fertility or a multi-watered, transverse arrangement of the fetus;
abnormal course of pregnancy, appointment of labor stimulation.
The symptoms of uterine rupture directly depend on the causes that provoked the damage, the stage of injury, concomitant diseases of the internal organs of the expectant mother. Complications can give gestosis, physical and moral exhaustion of the body of a woman in labor, chronic infectious diseases. The first symptoms are painful contractions, uncharacteristic opening of the uterus, swelling of its neck, difficulty urinating, painful sensations in the vaginal cavity. At the first gusts of uterine contractions become convulsive, blood discharge from the vagina, uncharacteristic of the birth process, appears. When a rupture occurs, a woman experiences severe sharp pain in the lower abdomen. After that, apathy is observed in women in labor, and the pain shock suffered causes the termination of labor activity. Uterine rupture can be easily diagnosed by the appearance and general condition of the mother’s body: pallor, palpitations, the appearance of sweat, nausea and possible vomiting. After uterine rupture, the fetus is located in the abdominal cavity, and its heart stops beating. Bleeding during ruptures can be very strong, its abundance depends on the size and location of the birth injury.
If specialists have managed to establish a real threat of a woman getting a uterine injury during childbirth, an immediate delivery is prescribed: a caesarean section or a special operation aimed at destroying the fetus. When the medical staff is faced with the question “whose life should I save: a woman in labor or a fetus?”, they always choose the life of a woman. After injury to the uterus during childbirth, hemostasis is immediately performed. Interventions with birth injuries of the uterus may involve supravaginal removal or even extirpation of the uterus. These are extreme measures that doctors take in emergency situations. For young patients with small damage and no infectious infection, the uterus is sutured. All procedures related to the restoration of the uterus are carried out in parallel with blood transfusion, since it is necessary to restore the amount of lost blood as soon as possible.
Cervical rupture occurs in many women in labor, according to some data about 60%. There are two types of these birth injuries: violent, spontaneous.
Depending on the depth of the damage received , all cervical injuries are divided into three stages:
The depth of the gap does not reach 2 cm;
The damage exceeds 2 cm, although it does not reach the vaginal arches;
The injury reaches the vaginal arches, and sometimes it can go to them.
Most often, the rupture of the cervix occurs in its left lateral part. The first symptoms indicating birth trauma of the cervix are postpartum bleeding from the vaginal cavity and contraction of the uterus itself. The blood flowing from the genital area has a bright scarlet color. The discharge can go continuously in a small trickle, sometimes together with clots. But medical practice knows cases when a cervical breakthrough was not accompanied by bleeding at all. If the resulting birth trauma was so severe that damage to the uterine arteries occurred, massive blood loss is observed, and patients experience severe pain shock. In case of untimely diagnosis of injury, complications may develop in the form of postpartum injuries, dysplasia, parametritis, etc.
To diagnose a rupture of the cervix, specialists conduct a postpartum examination using a gynecological mirror. A second examination is carried out after the removal of puffiness and the return of the uterine tissues to a state of rest — 6-48 hours after the birth of the child. If ruptures were found during the examination, they are immediately sewn up or an operation is prescribed up to two days after the end of the birth process.
The development of medicine and the training of highly qualified specialists have led to a significant reduction in the number of mechanical ruptures of the uterus. Uterine ruptures of a violent nature are becoming less frequent, but, unfortunately, cases of rupture of the uterus due to scarring of its walls are increasing. This is due to a large number of cesarean sections, abortions and plastic surgeons’ interventions.
Other birth injuries
The eversion of the uterus develops due to the improperly conducted postpartum period, often causes a painful shock. This birth trauma can manifest itself in two types: partial and complete. Inversion therapy consists in the immediate elimination of the shock state and straightening of the uterus. This procedure takes place under general anesthesia.
Sprains and ruptures of the pelvic joints: observed in women with softened pelvic joints and a large fetus. Ruptures are accompanied by stretching and divergence of bones, which leads to damage to the pelvic organs. This kind of injury is accompanied by severe pain, especially manifested when the legs are separated. Often, women with sprains may have impaired gait and coordination of movements. When diagnosing an injury, it is necessary to be examined by a traumatologist. The doctor often conducts a palpation examination and prescribes radiography of the pelvic joints. Trauma therapy provides for complete rest of the patient, tight bandaging and constant wearing of supportive corsets. If the pubic joint was damaged during the rupture, then it is necessary to perform an operation.
Urogenic and vaginal-rectal fistulas: manifest with prolonged stay of the fetal head in one position. The head can compress tissues and thereby disrupt blood circulation, which contributes to the development of necrosis. Sometimes fistulas can form due to damage to the tissues of the bladder or rectum during surgery.
Common causes of birth injuries of the mother
The formation of birth injuries causes a number of causes, which are divided into 2 groups: mechanical and histopathic.
The mechanical group includes interference with the natural process of childbirth and the use of forceps, the use of vacuum extraction, manual separation of the placenta, improper stimulation of childbirth. The use of such radical methods provokes complications in the course of pregnancy: carrying the baby in the womb or premature birth, incorrect location of the fetus, narrow pelvis of the mother, etc.
The histopathic group is based on the analysis of gynecological indicators of a woman. Uterine ruptures can be triggered by operations that a woman in labor has undergone in the past: cesarean section during a previous pregnancy, abortions, metroplasty. All of the above manipulations leave a scar on the uterus, which reduces the ability of the myometrium to contract during labor.
The risk group includes women with anatomical abnormalities of the genitals: a septum inside the uterus, hypoplasia, two-horned, rigidity, etc. Provoke the manifestation of birth injuries and diseases suffered during pregnancy: cystic drift, colpitis, chorionepithelioma.
Statistics show that ruptures of the perineum, vagina and cervix are more common in women who give birth for the first time. This is about 20% of the total number of births. Uterine ruptures are an order of magnitude less common — 0.05%. The main reason for such birth trauma is the complicated course of pregnancy and unqualified assistance of an obstetrician-gynecologist.
The soft tissues of the birth canal of a woman in labor are most often damaged with large fetal sizes, a narrow pelvis of the mother, inflammatory processes of the internal genitals, during rapid labor and the use of obstetric forceps.
Prevention of birth injuries
It is very difficult to prevent birth injuries, but if you carefully monitor your health and treat the formed inflammatory processes in the vaginal cavity in time, the risks of injury during the birth process are significantly reduced.
Many doctors advise pregnant women to massage the perineum regularly, which increases the elasticity of its tissues and will help to avoid tears and cracks in the future. You can start using massage treatments regardless of the period of pregnancy, but always after a warm shower. To improve the effect of the procedure, natural olive, sunflower, wheat oils should be used. A small amount of massage oil is applied to the perineum, labia and gently insert an oiled finger into the vagina to a depth of no more than three centimeters. Then we gently press on the vaginal wall adjacent to the surface of the rectum, and for five minutes we dynamically repeat the movements. Massage can be applied every five days.
No matter how hard a pregnant woman tries to protect herself and the baby from birth injuries, the main responsibility lies with obstetricians and gynecologists taking delivery. Specialists should monitor the successful course of the birth process and, in case of any complications, should hold the rapid movement of the fetal head. The actions of medical staff, according to obstetric instructions, can prevent perineal breakouts. The use of the “perineal protection” technique will help to preserve the tissues of the organs and perineum of the woman in labor.
An integrated approach will help prevent birth injuries to the mother and the born baby, then an easy birth will be guaranteed.
